Take control of pain with the right moves

When we have experienced musculoskeletal pain for some time, certain physiological changes often occur in our nervous system, both peripherally and at the spinal cord level, which can make us experience an unusual amount of pain. This phenomenon is called sensitization, where the threshold for nerve firing is lowered and our normal neural mechanism to block pain impulses no longer works well.

The mechanism in many ways works like a “pain memory.” The pain often spreads to other areas as well and can be triggered by seemingly trivial activities, as well as a number of other factors. The earlier treatment to address the pain is initiated, the more successful the treatment. Often, these conditions best respond to combined medical, manual therapy and holistic treatment.

The primary goal of orthopedic manual therapy is to reduce the barrage of neural pain impulses which reach the spinal cord and brain, by providing specific manual treatment and exercise therapy targeting affected joints and soft tissues and to reestablish a more normal movement pattern. Manual therapy may result in more relaxed and pliable muscle/fascia, joints that move better, and activated deep stabilizing muscles, all which help provide an environment for perceiving less pain. It is often helpful to perform frequent daily pain-free movements and avoid prolonged static positions.

A person’s attitude and emotional status can greatly affect the central sensitization mechanism, which may increase with excessive attention on the painful area and labeling the painful area (for example, my “bad back”). The sensitization can increase if we think about the painful area more than five to 10 times per day. Therefore, self-techniques to avoid this, and counseling can be helpful.

Other factors that may contribute to the sensitization process are poor sleep and fatigue, hypoglycemia, adrenal and thyroid problems. Inadequate nutrition and protein intake, food sensitivities, exposure to toxic excesses, stress and social isolation may also cause the sensitization process.

Peripherally, small nerve endings responsible for pain perception may start to produce neurogenic inflammation, which may require a combination of medications and dietary changes. Many people with musculoskeletal conditions need greater intake of protein and vitamin C, as well as other antioxidants, including vitamin E and selenium. Exercise outside increases the vitamin D level and can help improve our mood. Inactivity typically increases our pain perception, whereas frequent motion interferes with nerve impulses to our brain through certain pathways.

Appropriate conditioning exercises, such as walking, swimming or yoga, are often helpful. Sleep and stress management are also vital to reduce chronic pain, which can be aided by optimizing our sleeping posture and comfort through an appropriate mattress and pillow, relaxation exercise, meditation, diaphragmatic breathing exercise, counseling, acupuncture, herbal aids or medications.

Gunnar Mossberg, PT, MOMT, DPT, has practiced physical therapy in San Diego since 1982. He can be reached at gunnar@mossbergpt.com